1 State Members 2018 Benefit Guide 832 Weathered Rock Court Jefferson City, MO 65101. 800-487-0771 573-751-0771. myMCHCP. Your health can be one of the most important things in your life. Knowing what choices you have when it comes to your health care can be difficult. That's where Missouri Consolidated Health Care Plan ( MCHCP ) can help. We recognize that each of our Members are different and have unique needs. To meet your unique needs, MCHCP offers a variety of options when it comes to health care benefits. The 2018 MCHCP Benefit Guide will help you understand your benefits and make informed decisions. This booklet outlines the plan options available and explains how each one works. Medical Prescription Dental Vision (HSA Plan and PPOs). SELF Program Strive for Strive for Wellness Wellness.
2 Incentives Health Center 1. Medical & Pharmacy Plan Overview Medicare Prescription Health Savings Account (HSA) Plan PPO 600 Plan PPO 300 Plan Drug Only Plan Network Non-Network Network Non-Network Network Non-Network Network $1,650/individual $4,000/individual $600/individual $1,200/individual $300/individual $600/individual Deductible N/A. $3,300/family $8,000/family $1,200/family $2,400/family $600/family $1,200/family Medical $3,300/individual $5,000/individual $1,500/individual $3,000/individual $1,500/individual $3,000/individual N/A. Out-of-Pocket Maximum $6,600/family $10,000/family $3,000/family $6,000/family $3,000/family $6,000/family $5,100/individual $5,100/individual Prescription Combined with Medical $10,200/family No Maximum $10,200/family No Maximum No Maximum Out-of-Pocket Maximum Medicare: No Maxiumum Medicare: No Maxiumum MCHCP pays 100%.
3 Preventive Services MCHCP pays 100% 40% coinsurance MCHCP pays 100% 30% coinsurance MCHCP pays 100% 30% coinsurance for Preventive Pharmacy Services Primary Care or Mental Health: $25 copayment Specialist: $40 copayment Office Visit 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance Chiropractor: $20 copayment or 30% coinsurance Not Covered 50% of total cost of service, whichever is less Medicare: 10% coinsurance Urgent Care 20% coinsurance Network Benefit 10% coinsurance Network Benefit $50 copayment Network Benefit Not Covered Medicare: 10% coinsurance $100 copayment plus $100 copayment plus Emergency Room 20% coinsurance Network Benefit 10% coinsurance Network Benefit 10% coinsurance Network Benefit Not Covered Medicare: 10% coinsurance Medicare: 10% coinsurance Hospital (Inpatient) 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance Not Covered Lab and X-ray 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance Not Covered Surgery 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance Not Covered Days' Supply Generic Preferred Non-Preferred Prescription Drugs Generic: 10% coinsurance Generic and Preferred: 1-31 days $8 $35 $100.
4 32-60 days $16 $70 $200. Preferred: 20% coinsurance 40% coinsurance 61-90 days (home delivery) $20 $ $250. (Reduced costs for certain Non-Preferred: Non-Preferred: 61-90 days (retail) $24 $105 $300. diabetic drugs and supplies. 40% coinsurance 50% coinsurance Does not apply to Medicare) Medicare: Prescription drug copayments are the same as without Medicare but may have lower copayments in some instances. 4. Medical Plans Selecting the right medical plan is an important decision; one that can impact your finances. It's important to consider how the plans are similar, where they differ in cost, and which one is the right fit for you. All three of MCHCP 's medical plans the Health Savings Account (HSA) Plan, the PPO 600, and the PPO 300 offer the same benefits, such as: 100% coverage of preventive care such as preventive exams, vaccinations, age-specific screenings and much more when using a network provider.
5 Your choice of health care providers, pharmacies and hospitals from a nationwide network, usually at a lower cost to you. While the benefits are the same in all three medical plans, premium, deductible and out-of- pocket (OOP) costs vary. Because each member has different medical needs, the best plan choice may differ from person to person. Take the time to consider your situation and review this section closely. It may help determine which plan is the right fit for you. 5. Preventive Services Preventive services are designed to help identify potential health risks, allowing for early diagnosis and treatment. When done regularly, Members not only save valuable time and money, but also experience better overall health outcomes. Preventive care is covered at one hundred percent (100%) by MCHCP , regardless of your plan or whether you have met your deductible.
6 For benefits to be covered at 100%, they must be supplied by a network provider, billed as routine, without indication of an injury or illness, and meet preventive service guidelines. Please talk with your provider about which preventive care services and health screenings are the most appropriate for you and your age group, as he or she is your best source of information about your health. The preventive care Benefit includes, but is not limited to: Adult Alcohol Misuse, Screening and Behavioral Counseling Colorectal Cancer, Screening Depression, Screening Diabetes Mellitus, Screening Hepatitis C Virus Infection, Screening Immunizations Lung Cancer, Screening Obesity, Screening Preventive Exam, and other services ordered as part of the exam Routine lab and X-ray Services Skin Cancer, Counseling Tobacco Use, Counseling and Interventions Tuberculosis, Screening 6.
7 Men Abdominal Aortic Aneurysm, Screening Women BRCA-Related Cancer, Screening Breastfeeding, Counseling and Breast Pump Breast Cancer, Screening Cervical Cancer, Screening Osteoporosis, Screening Children Child Exam including depression, obesity, hearing and vision screenings and immunizations Depression in Adolescents, Screening MCHCP plans cover additional services as preventive care. For specific details, visit our website at 7. HSA Plan Overview The Health Savings Account (HSA) Plan is a qualified high-deductible plan that gives access to network providers at a lower cost. You will have a lower or no-cost premium with this plan, when compared to other MCHCP medical plans. Network Non-Network Preventive Services MCHCP pays 100% 40% coinsurance $1,650 Individual $4,000 Individual Deductible $3,300 Family $8,000 Family $3,300 Individual $5,000 Individual Medical OOP Max $6,600 Family $10,000 Family Prescription OOP Max Combined with Medical Medical Services 20% coinsurance 40% coinsurance Urgent Care 20% coinsurance Network Benefit Emergency Room 20% coinsurance Network Benefit Nurse Call Lines All MCHCP medical plan Members have access to 24-hour nurse call lines for health- related questions.
8 If you're unsure whether to go to the doctor for an illness or just want more information about a treatment or condition, registered nurses are on hand all day, every day to help. To use this service, call your medical plan's Nurse line. 8. The HSA offers several key advantages: Control: HSA funds accumulate to pay for IRS-qualified medical expenses, such as doctor and chiropractor fees, dental treatments, hospital bills, prescriptions and more. You decide how to spend it based on your health care needs and budget. Plus, HSA funds roll over from year to year; there is no use-it-or-lose-it policy. Flexibility: You can deposit (as long as you remain eligible) or withdraw money any time. There is a yearly maximum amount for how much you can put in your account. Portability: You own the HSA funds and may keep them - even if you later change health plans, leave your job or retire.
9 Tax Savings: There are triple tax savings with an HSA: 1. You can put away money for qualified medical expenses before taxes are taken out. This means you set aside income-tax-free dollars in an HSA to pay for qualified medical expenses. 2. Savings in your HSA grow tax-free. 3. You pay no taxes when you use HSA funds to pay for qualified medical expenses. MCHCP Contribution: MCHCP will contribute to the HSAs of active employees. MCHCP will contribute $300 for individual coverage and $600 for family coverage. How the HSA Plan Works 1. Active employee opens an HSA through Central Bank in Jefferson City. The bank will distribute a debit card, along with detailed information about the account. 2. Members may contribute to their HSA at any time. MCHCP will make an annual contribution to each active employee's HSA.
10 Members are also encouraged to fund their account up to the annual limit set by the IRS (see chart on page 10). Active employees may contribute through voluntary payroll deductions. Retirees may contribute by making deposits directly. 3. Members may monitor their account through Central Bank's website and/or monthly activity statements. 4. When visiting any health care provider or pharmacy, the member may pay for their expenses using HSA funds. No claim forms are required. 5. There are no copayments with the HSA Plan. Members will pay all of their medical and prescription expenses, until the annual deductible is met. The HSA may be used at any time for qualified expenses, as long as sufficient funds are available in the account. 6. Once the deductible is met, Members will pay coinsurance on covered expenses until their out-of- pocket maximum is reached.